Provider Demographics
NPI:1053888453
Name:WILDER, JANE BARBARA (RD)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:BARBARA
Last Name:WILDER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 FINNELL DR
Mailing Address - Street 2:
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02188-1110
Mailing Address - Country:US
Mailing Address - Phone:781-337-4600
Mailing Address - Fax:781-337-0270
Practice Address - Street 1:75 FINNELL DR
Practice Address - Street 2:
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02188-1110
Practice Address - Country:US
Practice Address - Phone:781-337-4600
Practice Address - Fax:781-337-0270
Is Sole Proprietor?:No
Enumeration Date:2018-10-24
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4685133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered